Taxpayers foot the bill for undocumented immigrants' medical care

WASHINGTON—As America counts the costs and consequences of illegal immigration, U.S. taxpayers are quietly footing a fast-growing multibillion-dollar tab for medical emergencies suffered by undocumented immigrants.

Whether they've entered the country illegally or overstayed their visas, illegal immigrants are ineligible for full coverage under Medicaid, the state/federal health plan for low-income Americans. Enforcement of the law tightens on July 1, when Medicaid recipients will begin having to show proof of citizenship and identity.

However, a little-known federal law requires state Medicaid programs to pay for emergency medical care for all undocumented immigrants who meet the program's financial and personal resource requirements.

The provision is intended to ensure that no one in the United States is denied lifesaving medical services. But those services are becoming more expensive as medical costs outpace inflation and uninsured illegal immigrants crowd the nation's emergency rooms.

Many are women giving birth. Others are people with chronic or mental illnesses, trauma victims or sick children.

The federal government generally pays about half the costs for such care under Medicaid, and states pick up the other half. But federal officials can't determine how much actually goes for the services, and many states don't closely track what they spend, either.

At the request of McClatchy Newspapers, some states took a closer look at the expenditures, which are a small but growing share of Medicaid's escalating costs. Even states with modest illegal immigrant populations have seen their costs soar. Minnesota's spending jumped 40 percent in two years, from $12.5 million in 2003 to $17.4 million in 2005.

In California, home to possibly 40 percent of the nation's estimated 12 million illegal immigrants, taxpayers have spent an average of $957 million a year since 2001 to pay for emergency care for illegals, the state reported.

Other states with large illegal immigrant populations, such as Texas and Arizona, don't know how much they spend because their computer data is inadequate. But in Houston, the Harris County Hospital District reported spending $97.3 million on uncompensated care for illegal immigrants, or about 14 percent of its annual operating costs.

In Georgia, the state reported that the cost of emergency care for undocumented immigrants nearly doubled in three years, to $112 million in 2005 from $58 million in 2002. In North Carolina, now home to an estimated 270,000 illegal immigrants, costs more than doubled, to $52.8 million in 2005 from $25.8 million in 2000. In Kentucky, the cost jumped to $9 million in 2005 from $2.2 million in 2003.

"Illegal immigration is becoming a very big-ticket health item for a lot of states. It's going to be a huge fiscal cost," said Steve Camarota, the research director of the Center for Immigration Studies, a non-partisan Washington public policy group.

Hospitals must examine all people who come to their emergency rooms and treat any with acute medical problems, regardless of the patient's immigration status or ability to pay.

When federal Medicaid officials deny reimbursement for illegal immigrant care that isn't considered an emergency, hospitals are stuck with the bill and typically pass the charges on to other patients in the form of higher costs.

Medicaid defines an "emergency medical condition" as one with severe acute symptoms that, without immediate attention, could jeopardize a patient's health, cause impairment to bodily functions or cause a body part or organ to malfunction. Medicaid's emergency-only coverage forces taxpayers to purchase the most expensive form of health care with no way to hold down costs.

"If you have an (illegal immigrant) child with asthma, we can give that child treatment and inhalers, or we can see that child land in the emergency room every couple of months," said Cindy Mann, a research professor at Georgetown University's Health Policy Institute. "It's better both for the child and the family, and certainly for the costs, to say `Let's treat his asthma rather than wait until it becomes life-threatening and he ends up in the emergency room.'"

In 2003, Congress agreed to pay doctors and hospitals an additional $1 billion between 2005 and 2008 to help pay for uncompensated emergency care that Medicaid won't cover.

Some health care experts argue that the federal government should consider providing a modest coverage plan for low-income illegal immigrants in addition to the emergency coverage under Medicaid. They argue that if comprehensive health care coverage were available to them, undocumented aliens could get preventive care through Medicaid or community health centers, and U.S. taxpayers could avoid paying for more expensive emergency room care.

Even those who support better coverage for illegal immigrants, however, realize that it's a tough sell in an era of shrinking federal funds and rising medical costs, said Sonal Ambegaokar, a health policy attorney at the National Immigration Law Center in Los Angeles.

Immigrants' rights groups and health care advocates are pushing for incremental changes, such as providing public health coverage for all children—including undocumented aliens—as Illinois plans to do. A legislative proposal in California would do the same.